Previous research has linked invasive devices and clinical practice to hospital-acquired infections (HAIs). There is now evidence suggesting that elements of nursing care are also linked to the prevalence of HAIs. Few studies have rigorously examined the possible underlying mechanisms of the relationship between nurse staffing and HAIs. In the American Journal of Infection Control, my colleagues and I had a study published that assessed job-related burnout among registered nurses to determine its accountability for the relationship between nurse staffing and infections acquired during hospital stays. Burnout Affects Infection Rate Our findings show that job-related burnout among nurses appears to be a plausible explanation for some HAIs. Nurses had an average total of 17 years experience, caring for an average of about six patients. Almost 37% reported high levels of burnout. At the hospitals involved in the study, 16 of 1,000 patients acquired some type of infection, particularly urinary tract infections (UTIs), surgical site infections (SSIs), and gastrointestinal infections, as well as pneumonia. For modeling and further analysis, we limited the types of infection to UTIs and SSIs. As patient loads escalated, the number of UTIs and SSIs increased significantly. In additional modeling, nurse burnout was highly associated with these infections, a finding that hasn’t been reported in previous research. A 10% increase in a hospital’s composition of high-burnout nurses was linked to an increase of nearly one UTI and two SSIs per 1,000 patients. Perhaps the most important finding from our model was that reducing nurse burnout by 30% could prevent more than 4,000 UTIs and more than 2,200 SSIs each year and save up to $69 million...

Rates of surgical site infection (SSI) appear to be similar between cesarean deliveries using chlorhexidine-alcohol and those using povidone-iodine. A retrospective cohort review found that the duration of cesarean delivery was the only significant predictor of SSI. Abstract: Obstetrics & Gynecology, November...

Surgical site infections (SSIs) are the most common complication facing colorectal surgery patients, occurring in 15% to 30% of cases. SSIs prolong hospitalization, increase readmissions, require subsequent treatment, affect quality of life, and increase healthcare costs to the tune of $1 billion annually. Research has not shown an association between adherence to well-known infection control process measures and substantial SSI reduction. While the occurrence of SSIs can never be fully eliminated in any feasible scheme, many can be prevented. Addressing SSIs as a Team In a study published in the August 2012 Journal of the American College of Surgeons, my colleagues and I found that physicians and nurses often feel as though they know what needs to be done to improve safety for colorectal surgery patients, but they feel disempowered. Using these perceptions as the basis for our study, we tested the implementation of a surgery-based comprehensive unit-based safety program (CUSP) designed to address SSIs. Participants in CUSP met monthly for as little as 1 hour in small groups of surgeons, nurses, operating room technicians, and anesthesiologists, along with a senior hospital executive who ensured access to necessary resources. CUSP team members identified six key interventions that were believed to help reduce SSIs: 1. Standardization of skin preparation. 2. Prescription of preoperative chlorhexidine showers. 3. Restricted use of by-mouth bowel cleansing solution before procedures. 4. Warming of patients in the pre-anesthesia area. 5. Adoption of enhanced sterile techniques for bowel and skin portions of the case. 6. Addressing lapses in prophylactic antibiotics. With a focus on these areas, simple safety checklists were created, and caregivers were urged to speak...

The presence of urinary tract infections and surgical site infections appears to be significantly associated with patient-to-nurse ratios, according to a study from Rutgers University. Hospitals that reduced burnout by 30% had 6,239 fewer infections per year, amounting to potential savings of nearly $68 million annually. Abstract: American Journal of Infection Control, August...

The 2012 annual meeting of the American Academy of Orthopaedic Surgeons was held from February 7-11 in San Francisco. The features below highlight just some of the studies that emerged from the meeting. >> Analyzing Deep SSIs in Total Hip Arthroplasty >> Pain Following TKA Tied to Osteoarthritis >> Are Antibiotics Necessary for Clean Soft Tissue Hand Surgery? >> Defensive Medicine Costly in Orthopaedic Surgery >> Trending Lumbar Spinal Stenosis Surgery Analyzing Deep SSIs in Total Hip Arthroplasty The Particulars: Deep surgical site infections (SSIs) are severe complications that may occur in total hip arthroplasty (THA). Few studies have explored patient- and surgical-related risk factors for SSIs associated with THA. Data Breakdown: A prospective cohort study of 30,491 THA procedures found an incidence rate of 0.51% for deep SSIs. Patient factors associated with deep SSI were female gender, BMI of 30 kg/m2 or higher, and American Society of Anesthesiologist risk score of 3 or greater. Patient factors not associated with an increased risk of SSIs were age, arthritis diagnosis, diabetes, and race. Bilateral THA procedures were associated with a 5.32-times increased risk of SSIs when compared with unilateral THA procedures. Surgeon and hospital case volumes, use of antibiotic cement, fixation method, laminar flow, surgical approach, and fellowship training were not associated with SSIs. Take Home Pearl: Female gender, obesity, chronic medical conditions, and bilateral THA procedures appear to be associated with deep SSIs. Pain Following TKA Tied to Osteoarthritis The Particulars: Little is known regarding the association between objective ratings of preoperative osteoarthritis (OA) and pain and dissatisfaction following total knee arthroplasty (TKA). Data Breakdown: In a study, investigators...